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, <br /> • oa-a3� <br /> � COMBINED JOIIVT NOTII+'ICATION FORM-wATER RESOURCE APPLICATION � <br /> Use this form to noNfy/apply W tbe Minnehaha Cceek Waberslud District (MCWD),their engineering con�ultarnts,the <br /> DNR.and the Hennepin Conservation District of a proposed watedwetland ptvject vr wark which may fail within theic <br /> ,jurisdiction.'Ihese agencies should advisc you of their jurisdiction or permit requirements witbin 10 days. Fill out this <br /> fornt complctcly and mail a cvpy,with plan,maps,etc...to the MCWD,C.rcay Freshwater Center,Navure,2500 <br /> Shadywood Road,5uite 37,Hxcelsior, 1�Q�T 55331. Keep a copy for your record.4. YOU MUST OBTA,IN ALL <br /> REQUIREp AUTHORrZATION3 BEFORE BL�C3IIVN'lNG WORK, <br /> 1.A li 's N (Las�Fasr,HLI-) Pl�o�Nu. G}c�'2 -4'j�O � � Z � � <br /> Address( [iFD,Bo7�#,C" ,,$tatE,ZiP) � 2�r .. Y� <br /> N � � .G.l--� <br /> 2. Locazion o�proposed PmJect(Atmch deawing w/dir�ctions to sitc): <br /> OUNI'Y QTR 3BC�10N(s) SECTlO�IV(s) Tn'1�VNSHiP(s) RANGE(s) Lot,Block,Subdivlsion <br /> ��� <br /> ��o��: R ��: � s <br /> 3. LENGTH OF SHORE AFFEt"1'ED(in feet): VOLUME OF OR GfXCq,VA'ITON(Cubic yar�ds): <br /> ARFA FII.LED OR BXCAYATED LS Acres,OR Squarc Fcxt <br /> 4. 'IY'PE OF PC+.�LM1T BEING APPLIFD FOR (Check a11 that ap�ply): <br /> ❑STORMWA'IER MANAGEMENI'PLAN ❑FLOODPL.AIN ALTERATION ❑WETLAND ALTERATfON <br /> CJSHORELINE IMP'ROVIIV�Tf I�S1'ORM SEVVER OT.TI`FALLS EXCAVA'I70N(DRBDGOVG) <br /> � WiLDLffE <br /> b BLANK�K�I' ❑ICE RIDCi�REMpVq,�, b_ NAVIGATIUN <br /> �.❑R�rAaNirtC w� c.C7 Bto�tanv��NG <br /> �S�r�r,��c�utv�xT c�ossn�tc� <br /> OTHER(pESCRIBE) N. 'Z �F' <br /> 4a. APPLICAN'x"$ �FSIIVTATIVE:(I.icen .Engineer,etc.--) Include name,acl�css dt pbne c ' <br /> � �2=�#�s- a <br /> �.�'Z►��' . 2.��. � �J�2rrS 94 �;,,�1� 5�v}..c,u�ln �+P.Cd�+,d.. .s� <br /> 5.PROJEC7'PURPOSE(why is rhis pno�ect fleeded-wUsat benefits will ic p�rovide?) <br /> N�r ' �. l ho�� <br /> 6.ALTERIVATIVFS(descrlbc other sires or nnethoda tl�et caild be used m a�chieve the pur�msc of Y�l�Je�while avoicling or <br /> minitnizhtg watedv�retland'anpacq, Aw�ch additio�l s6eets,if�eeded. <br /> 7.DATES: Pmposec!sts�.t of activity: I O v ��P�= p � <br /> I laed r�o�c on draqriti <br /> 8. AD OF DJOIIQiNC�P OPERTY O (AQach list jf <br /> r � <br /> 9. PERMITS HAVE BEEIV ItECE[vSU (R)OR APPL1Ep FOR(A)FROM:��NR_„_ARMy(�RpS OF ENC�R <br /> --._COUN7'Y CIIY IbQ�i POLL'CTlION CON'�'ROL AC3ENCY <br /> I heneby notiFy the reaipic�ofthis form of the pzoject prqppsed hareia�d iequest i be advised of any�err�tite or o�hcr dete�minatlns <br /> � ect tMat I must oblain.T undetstsnd that pToceedi0g with wo�befim al1 tequited aut�ori�atians ane obtained may be <br /> to ta�e�d/or 1 u�mmi�re,civil and/or criminal p�. <br /> � Puson P Pto'ect pr t <br /> � � r � , <br /> �,; <br /> JUL 17 Z� `�': <br /> .�. <br /> ��:� . <br /> . .� <br /> S0i�0'd Z890ZLbzZ9 Q3HS�131d�1 7133�1� dHdH3NNIW Lb:Zt £00Z—ZT—H3� <br />